By Genevieve Pollock
CHICAGO, MARCH 3, 2011 (Zenit.org).- A Chicago Catholic medical center instituted a ground-breaking protocol to save the babies of women who change their minds while in the process of second-trimester abortions.
ZENIT interviewed Resurrectionist Sister Donna Marie Wolowicki, executive vice president and CEO of Resurrection Medical Center, and Erica Laethem, director of clinical ethics at Resurrection Health Care, about this new protocol, which has aided three women to halt the abortion process since October.
Very little medical information is available about this reversal procedure, but there are cases where women, sometimes misinformed or pressured by others to have an abortion, reveal that they want to stop the abortion process and instead carry their babies to term.
Often, these women change their minds after talking with a pro-life worker who may accompany them to the hospital or seeing an ultrasound picture of the fetus in their wombs.
In this joint interview with ZENIT, Sister Wolowicki and Laethem explain how this hospital protocol aids women by offering support, emphasis on their free and informed consent, medical intervention, and follow-up prenatal care. Other hospitals are already requesting to share this policy and protocol.
ZENIT: Could you help us to understand the medical facts behind this intervention that allows a woman in the middle of an abortion procedure to change her mind? How does it work? Are we talking about late-term abortions in these cases, or about how many weeks old are the unborn babies when their mothers would seek this multi-day abortion procedure?
Laethem: The Bethlehem Project is designed to offer women a chance to stop a second-trimester abortion procedure that they have initiated elsewhere. The second trimester comprises the time from 13 to 27 weeks in the pregnancy.
This possibility to halt the abortion process exists because a second-trimester induced abortion is a multi-day procedure that involves two major steps: dilation and evacuation. The process lasts for two to three days.
On the first day, small sticks, often made of a dry, compressed seaweed product called laminaria are inserted into the cervix. Over several hours, they absorb water and expand, thereby dilating the cervix.
On the second day, the clinician checks to see if the cervix is sufficiently dilated to remove the fetus. If it is not, then more laminaria sticks are inserted.
When the cervix is large enough, then a medication may be given to soften the uterus so that the fetus can be removed.
Resurrection Health Care does not carry out any aspect of the induced abortion process; this generally occurs in an abortion clinic.
Our protocol offers the possibility to stop the abortion process after the laminaria sticks have been inserted elsewhere, while the fetus is still in the womb.
ZENIT: Once a woman has begun the abortion process, she has put her baby at risk, but Resurrection Medical Center is showing that there is still hope to save the unborn child. Why has this practice of reversing the abortion been so rare in the medical world? Do you think it will become more common in the future, in other Catholic hospitals or secular institutions?
Sister Wolowicki: Not all abortion procedures are the same, and only some can be reversed once they have begun.
The second trimester abortion process takes place over a few days, and can often be stopped after the dilation process has been initiated.
There is not much data available about the number of health care providers that reverse second trimester abortions, so we cannot speak to the frequency that reversals occur.
We can say that second-trimester abortions are less common than first-trimester abortions. The Guttmacher Institute estimates that about 12% of abortions occur after the first trimester of pregnancy.
We do not know how many women change their minds after initiating the process.
Since it is not a common occurrence that a woman would initiate the second trimester abortion process, change her mind, and come to our hospital seeking help, we thought it was important to ensure that our staff in the emergency department and in obstetrics had a clear process they could follow that would protect the woman’s privacy, ensure informed consent free from coercion, provide safe medical interventions, assure appropriate observation after the laminaria sticks are removed, provide discharge instructions, and offer assistance with finding close-to-home prenatal care as well as any counseling needs or other resources she might need.
We have found that having a formalized protocol and policy has streamlined the process and ensured that no steps of the detailed process are missed.
We have received several requests from other hospitals to share the policy and protocol with them.
So far, none of them have said that they do not already remove laminaria, but they have all said that they do not have a policy or protocol in place to do so.
ZENIT: Could you say something about the nature of the cooperation between pro-life workers and medical staff at the hospital?
Sister Wolowicki: Although we are not in a partnership with pro-life groups, we collaborate with them to assist women who have changed their minds after having initiated the abortion process.
Oftentimes, women who come to the hospital seeking the removal of laminaria do so after talking with a pro-life counselor and after visiting the Women’s Center.
When they enter the hospital, the counselor generally stays in the waiting room while the health care team talks with the woman about the nature of her pregnancy, what was done in the abortion clinic, her medical history, and what could be done to stop the abortion process.
We also think it is important to provide her with an opportunity to share her own thoughts and concerns. This is to protect the woman’s privacy and to ensure informed consent.
After this is done, the clinician asks the woman whether she would like the pro-life counselor to come in. There is no pressure either way.
In our experience, most women have asked that the counselor come back into the room. Since the counselors are often the first people who reach out to them, there is often a relationship there.
We work together with the pro-life groups to meet the woman’s needs after the removal of laminaria as well..
ZENIT: Why does the Resurrection Medical Center leadership think it so important to offer women the choice of reversing the abortion procedure?
Sister Wolowicki: We think that if we are really committed to human life and dignity, we ought to do everything we can to help women facing unplanned pregnancies.
We believe that if a mother feels important, valued, and cared for, she will be better able to share her love with her baby.
Sometimes, we get the idea that women facing an unplanned pregnancy feel like everybody is trying to give them advice, but nobody is really listening.
It is unconscionable for us not to reach out to help.
ZENIT: Could you say something more about how the hospital staff assures that the mother is making a free, non-coerced choice to reverse the abortion?
Laethem: Since the removal of laminaria is a medical procedure, it is necessary to ensure that a free and informed consent is provided by the woman. This is both a legal and an ethical obligation.
As a general rule, this requires that the health care provider provide information about the essential nature of the proposed intervention and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and ethically legitimate alternatives, if they exist.
If a woman is unsure of whether or not she wants to give consent to the removal of laminaria, we try to give her time, support, and space, if she needs it, as she considers her decision.
Sometimes, this will involve allowing the woman to speak with her physician or medical care team privately, without others in the room, if she would like to do so.
ZENIT: Thus far, since the October implementation of this protocol, you have had three women go through this procedure. In your experience, why would a woman change her mind and seek this particular intervention?
Sister Wolowicki: On this question, we can only speculate. Some women have significant pressure to begin the abortion procedure in the first place — pressure from boyfriends, husbands, friends, parents, family members, and sometimes, maybe even health care providers. For others, these are the people who try to talk them out of having an abortion.
Women might feel as though they have nowhere to turn for support, and that they will have to bear the burden of caring for their child alone.
Some say that they feel like abortion is their only choice, or at least, their best choice given their very difficult circumstances.
Some women are surprised and relieved to find they do not have to go through this alone, and that there are people willing to provide them with care and support throughout their pregnancy and afterwards.
In our experience, we have seen a significant number of women who simply did not realize that they were carrying a whole, distinct, unique, living human being in their womb.
When they saw their baby for the first time in an ultrasound, they were surprised to find that he or she had arms, legs, and a beating heart.
When they saw the image, they realized they not just carrying a ‘blob of tissue,’ but another human. Seeing the ultrasound seems to have been a decisive moment for many women.
ZENIT: What do you see as the main bioethical principles supporting this protocol?
Laethem: There are several that are relevant, so I will just mention a few of the main ones that guided the design of this protocol.
Respect for human life and dignity is one principle with both a negative implication (a “Thou shall not” dimension) and a positive implication (a “Thou shall” dimension).
It implies not intentionally taking the life of an innocent human being, and, at the same time, it implies providing those basic means of preserving life that are necessary for survival, which includes, among other things, access to health care.
The principle of autonomy is respected by ensuring that the woman is fully informed of the proposed intervention and its benefits; its risks, side-effects, consequences, and cost; and any reasonable and ethically legitimate alternatives, if they exist. It also involves ensuring that the woman has the opportunity to provide consent in a way that is free from coercion.
Another guiding principle is solidarity. As John Paul II pointed out, solidarity is not just a feeling of vague compassion or shallow distress at the misfortunes of so many people, but rather, it is a firm and persevering determination to commit oneself to the common good; that is to say, to the good of all and of each individual, because we are all really responsible for all.
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For more information on hospital protocol: [email protected]